巩膜环扎带术后重眼综合征1例

A case of heavy eye syndrome after scleral buckling surgery

33岁男性,因“右眼环扎带术后逐渐出现内下斜15年”就诊。视力:右眼-20.00 DS→0.1;左眼-22.00 DS/-2.0 DC×100°→0.2。双眼眼压Tn。眼位:右眼固定性内下斜视,内斜>45°,右眼低位10°。眼球运动:右眼外转、上转完全受限。裂隙灯检查:右眼颞上方角膜透明,眼内结构窥不入;左眼高度近视眼底改变,余无殊。眼眶CT显示右侧眼球下内转位,上直肌(SR)内移,外直肌(LR)下移,左侧眼球内转位,双眼高度近视表现。该患者右眼重眼综合征、右眼环扎带术后诊断明确,请眼底组专家评估其视网膜情况,拟行右眼环扎带取出联合右眼改良Yokoyama手术。但进行Yokoyama手术时发现患者LR前段及SR后段与巩膜严重粘连,遂调整手术方案为右眼内直肌(MR)后徙12 mm联合上直肌转位术(SRT)联合LR-SR联结术。术后1.5个月仍残留内斜10°,遂行左眼斜视手术:左MR后徙5 mm联合LR截除7 mm。左眼斜视术后随访3个月,眼位正,右眼外转及上转明显改善,未出现复发性视网膜脱离。讨论体会:对于环扎带术后出现的斜视,环扎带是否取出需权衡利弊,一旦取出,需密切随访视网膜情况;Yokoyama术中,发现眼外肌粘连严重时,需及时调整手术方案,此病例SRT联合SR-LR联结术也获得了较为理想的效果。

A 33-year-old male presented with progressive eso-hypotropia of the right eye after scleral buckling procedure for 15 years.Visual acuity:right eye-20.00 DS→0.1;left eye-22.00 DS/-2.0 DC×100→0.2.The intraocular pressure in both eyes was Tn.Special examination of strabismus:more than 45°esodeviation in the right eye and 10°right hypodeviation.Abduction and supraduction of the right eye were completely limited.Slit-lamp examination:the right eye had a transparent supratemporal cornea with no intraocular structures visible;the left eye had highly myopic fundus changes with a normal anterior segment.Orbital CT showed that eso-hypotropia of the right eye with superior rectus(SR)displaced medially and lateral rectus(LR)displaced inferiorly,esotropia of the left eye,and binocular high axial myopia.The patient was diagnosed with heavy eye syndrome and strabismus following scleral buckling surgery.After evaluating the retinal condition of the patient,a combination of scleral buckle removal and modified Yokoyama surgery of the right eye was proposed.However,during the Yokoyama surgery,the anterior LR and the posterior SR were found to be severely adherent to the sclera.The surgical plan was adjusted to 12mm medial rectus(MR)muscle recession in the right eye in combination with superior rectus muscle transposition(SRT)associated with LR-SR muscle belly union.1.5 months after the surgery,10°esotropia remained,so strabismus surgery was performed on the left eye:5mm MR recession combined with 7mm LR resection.3 months after left eye strabismus surgery,almost orthophoria was shown with significantly improved abduction and supraduction of the right eye,and no recurrent retinal detachment was detected on fundus examination.For strabismus after scleral buckling surgery,the pros and cons of scleral buckle removal should be weighed before strabismus surgery.Once the buckle is removed,close follow-up should be performed to detect recurrent retinal detachment.When severe extraocular muscle adhesions are found during the Yokoyama procedure,the surgical plan needs to be adjusted promptly,and in this case,SRT combined with SR-LR union achieved good results.